Conscientiousness and Academic Performance in Medical Students: A Systematic Review Across Training Stages and Assessment Types

Abstract

Background: Cognitive measures explain only part of why some medical students perform well while others struggle. Conscientiousness is a promising non-cognitive factor, but evidence in medical education remains scattered, particularly regarding whether its association with performance varies across assessment types and stages of training. Methods: This systematic review followed PRISMA 2020 guidance and examined the association between conscientiousness and academic performance in undergraduate medical students. PubMed, ScienceDirect, and PsycINFO were searched on 5 October 2025. Twelve studies involving 3847 medical students met the eligibility criteria. Because the included studies reported heterogeneous outcomes and statistical metrics, findings were synthesized narratively. Results: Across the included studies, conscientiousness showed a generally positive association with academic performance, with reported estimates typically ranging from 0.18 to 0.48. Associations appeared somewhat stronger in clinical assessments than in preclinical written examinations and were minimal in procedural skills, although formal subgroup meta-analysis was not performed. Longitudinal studies also suggested that the predictive relevance of conscientiousness may become more apparent across later stages of training. Conclusion: Conscientiousness is a modest and generally consistent correlate of academic performance in medical students. Its relevance appears greater in learning environments that require sustained self-regulation and autonomous effort. These findings do not support the use of conscientiousness for high-stakes admissions decisions. Instead, they support using these findings to guide targeted educational support and curriculum design that strengthen students’ planning, follow-through, and adaptive self-regulation.